Thorac Cardiovasc Surg 2013; 61 - SC68
DOI: 10.1055/s-0032-1332566

Complex reconstruction of left anterior descending: Clinical midterm and long term results

B Danner 1, N Teucher 1, R Seipelt 1, AF Popov 1, I Bougioukas 1, F Jebran 1, D Zenker 1, M Großmann 1, FA Schöndube 1
  • 1Universitätsmedizin Göttingen, Göttingen, Germany

Objectives: Diffuse coronary artery disease (CAD) is common in cardiac surgery. Sequential stenosis and diffuse atherosclerosis are challenging in coronary artery bypass grafting (CABG). Especially in multiple stenosis and severe sequential calcification of coronary arteries, revascularization is technical demanding. We report our experience of venous patch reconstruction of the LAD with reinsertion of the left internal thoracic artery (LITA).

Methods: Retrospectively, we reviewed our database for patients with venous-patch reconstruction of the LAD with insertion of the LITA. 44 patients could be detected between 11/2005 – 5/2012. Mean age was 67.7 years, 75% of them were male. Mean number of bypass grafts was 3.8, and in 7 patients (16%) a concomitant procedure was performed (2 MVR, 5 AVR).

Results: The average length of the venous patch was 42.4 mm and mean transit flow measurement at LITA was 43.7 ml/min. In 14% of patients a thrombendarterectomy was additionally performed. Median Syntax Score was 40.7 (range 31 – 56); mean aortic clamping time overall was 110 min, and for solitary CABG 104 min, respectively. Except for three patients with need for IABP, weaning from extracorporeal circulation was uneventful. Reexploration for bleeding at LAD anastomosis was necessary in one patient. In another patient a PTCA of the distal LAD was necessary due to occlusion. We observed 4 in-hospital deaths (9.1%) due to non-cardiac reasons. At follow up (93% complete) a re-intervention (PTCA) at the LAD was necessary in 3 patients. One patient died due to gastrointestinal bleeding, and another patient due to endocarditis. Overall, estimated survival time was mean 64 months (figure 1).

Fig. 1

Conclusions: Reconstruction of the LAD with a venous patch reconstruction followed by LITA insertion is a feasible technique providing good flow and adequate clinical results. Long term follow up was as good in this high risk group with severely diffused coronary artery disease.